Provider Demographics
NPI:1417257734
Name:YORK, AUDRA (LPC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:GENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4325 LAUREL ST
Mailing Address - Street 2:SUITE 230A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5364
Mailing Address - Country:US
Mailing Address - Phone:907-952-8532
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-563-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
AK815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist